The catch-22 of catching z's

A new Institute of Medicine report finds that medical residents are still--despite the institution of work-hour limits--not sleeping enough. It's a finding that almost anyone (except those grumpy old guys who also walked uphill both ways to their residencies) would agree with.

But the report also captures the damned-if-you-do, damned-if-you-don't nature of this problem. One of the IoM's major concerns about sleepy residents was that they conduct inadequate handoffs. Yet, one of the primary arguments against work-hour limits was that they would require more handoffs. So is the best way to reduce errors to reduce the number of handoffs or to increase them but hope that well-rested residents will mess them up less often? Already we're stuck, and we haven't even gotten into the whole money part of the problem.

Funny side note: The New York Times article about the IOM report uses a chart from a study of residents' sleep habits and self-reported errors. The chart shows the two factors to be inversely related--more sleep, fewer errors. But we have to wonder: isn't any resident who says he or she gets 7-8 hours of sleep obviously a liar? No wonder only 21% of them admit to having made an error.

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